I need a safe place to talk!  
Confidential student survey for student concerns
Sign in to Google to save your progress. Learn more
Email *
Student Name
What is your gender *
When do you graduate? *
Student email address that is used consistently *
What is your phone number?
Are you experiencing any of the following?   *
Required
Do you think you need counseling? *
Would you be willing to participate in a group at school that will help you address the issue that you are confronted with? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Atlanta Public Schools. Report Abuse